title: Modified Hodge test: A useful and the low-cost phenotypic method for detection of carbapenemase producers in Enterobacteriaceae members.
abstract: BACKGROUND
  The global spread of antimicrobial resistance has acquired greater significance in the public health perspective. Drug resistance has posed a threat for the management of various hospital-acquired infections (HAI). For bacteria producing extended spectrum ß lactamase, carbapenems are the drug of choice. However, treatment failures are still a cause of concern due to carbapenemase producers.
  
  
  OBJECTIVE
  Various phenotypic and genotypic methods are available for the detection of carbapenemase producers. Studies thus far have mostly concentrated on comparing various methods for detection of carbapenemase producers. We used low-cost and the easily performed modified Hodge test (MHT) for detecting the carbapenemase producers in Enterobacteriaceae members isolated from various clinical specimens.
  
  
  METHODS
  The study included 1072 clinical isolates of Enterobacteriaceae collected in India between April 2008 and February 2010. MHT was performed on all the isolates in accordance with CDC and CLSI guidelines.
  
  
  RESULTS
  The carbapenemase activity was detected in 35.9% (385/1072) of the isolates. Klebsiella spp. 28.7% (80/278), Citrobacter spp. 20.4% (25/122), 11.3% (38/334) in E. coli, 20.3% (45/221) in Enterobacter spp., and 16.2% (9/117) in Proteus spp. revealed variable resistance activities against carbapenems.
  
  
  CONCLUSIONS
  Enterobacteriaceae members are among the most common and easily transferable bacterial species responsible for severe HAI. This study revealed a high percentage of Enterobacteriaceae clinical isolates producing carbapenemases in India. Detection of such bacteria, formulating hospital antibiogram, and monitoring the usage of antimicrobial drugs is recommended.
authors.affiliation: Department of Microbiology, Apollo Health City, Jubilee Hills, Hyderabad, Andhra Pradesh, India.
authors.forename: K V
authors.initials: KV
authors.lastname: Ramana
authors.forename: Ratna
authors.initials: R
authors.lastname: Rao
authors.forename: Ch V
authors.initials: ChV
authors.lastname: Sharada
authors.forename: Ma
authors.initials: M
authors.lastname: Kareem
authors.forename: L Rajashekar
authors.initials: LR
authors.lastname: Reddy
authors.forename: Ms
authors.initials: M
authors.lastname: Ratna Mani
keywords: Carbapenemase; Enterobacteriaceae; modified Hodge test